Attachment 4 - Past Performance Questionnaire.pdf
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- Dorm Cameras
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- FA442725Q1120
About this file
This document is a Past Performance Questionnaire, a standardized form used to evaluate and rate a contractor's performance across six key areas: quality, schedule, cost control, management, small business utilization, and regulatory compliance. The form provides a detailed rating scale with five performance levels ranging from Exceptional to Unsatisfactory, with specific criteria for each rating. Contractors are assessed on their ability to meet contractual requirements, solve problems, and deliver value to the government. The questionnaire allows the evaluator to provide ratings, justification for those ratings, and additional remarks, and includes spaces for the respondent's contact information and signature. The purpose of this document is to create a comprehensive assessment of a contractor's past performance that can be used in future contract evaluations and selection processes.
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Text version
PAST PERFORMANCE QUESTIONNAIRE
1. Reference Information:
Contract Number (Include task order number(s)) if applicable:
Contract Value:
Contractor performed as: Prime Contractor Sub-Contractor
2. Description of Work Completed:
3. Contractor Performance Assessment Reporting Rating:
Below please provide a rating based on the following table to rate the contractor’s performance.
Exceptional Performance meets contractual requirements and exceeds many to the Government’s benefit.
The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.
Very Good Performance meets contractual requirements and exceeds some to the Government’s benefit.
The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were effective.
Satisfactory Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.
Marginal Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.
Unsatisfactory Performance does not meet most contractual requirements, and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.
Note: Ratings other than a satisfactory rating should include accompanying rationale to justify the higher or lower rating.
3.1: Quality Rating:
Exceptional Very Good Satisfactory Marginal Unsatisfactory
3.2: Schedule Rating:
Exceptional Very Good Satisfactory Marginal Unsatisfactory
3.3: Cost Control Rating:
Exceptional Very Good Satisfactory Marginal Unsatisfactory
3.4: Management Rating:
Exceptional Very Good Satisfactory Marginal Unsatisfactory
3.5: Small Business Rating:
Exceptional Very Good Satisfactory Marginal Unsatisfactory
3.6: Regulatory Rating:
Exceptional Very Good Satisfactory Marginal Unsatisfactory
Justification for rating:
Additional Remarks:
Respondents Signature Name:
Email:
Phone Number:
Agency/Company:
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